Cancel culture: exploring the unintended consequences of cancelling the Canadian national licensing clinical examination
DOI:
https://doi.org/10.36834/cmej.73889Abstract
Assessment drives learning. However, when it comes to high-stakes examinations (e.g., for licensure or certification), these assessments of learning may be seen as unnecessary hurdles by some. Licensing clinical skills assessment in particular have come under fire over the years. Recently, assessments such as the Medical Council of Canada Qualifying Examination Part II, a clinical skills objective structured clinical examination, have been permanently cancelled. The authors explore potential consequences of this cancellation including those that are inadvertent and undesirable. Future next steps for clinical skills assessment are explored.
Metrics
References
Schuwirth L, van der Vleuten C. Merging views on assessment. Med Educ. 2004;38(12):1208-1210. https://doi.org/10.1111/j.1365-2929.2004.02055.x
Wood T. Assessment not only drives learning, it may also help learning. Med Educ. 2009;43(1):5-6. https://doi.org/10.1111/j.1365-2923.2008.03237
Wormald BW, Schoeman S, Somasunderam A, Penn M. Assessment drives learning: an unavoidable truth? Anat Sci Educ. 2009;2(5):199-204. https://doi.org/10.1002/ase.102
Scott IM. Beyond ‘driving’: The relationship between assessment, performance and learning. Med Educ. 2020;54(1):54-59. https://doi.org/10.1111/medu.13935
Pugh D, Regehr G. Taking the sting out of assessment: is there a role for progress testing? Med Educ. 2016;50(7):721-729. https://doi.org/10.1111/medu.12985
Lougheed T. Is it time to rethink the MCCQE Part II? Can Med Educ J. 2016;7(1):e87-e88
Jayakumar KL. The limited value of USMLE Step 2CS (letter to the editor). Acad Med. 2018;93(3):345
Lehman EP, Guercio JR. The Step 2 clinical skills exam – a poor value proposition. NEJM. 2013;368(10):889-891. https://doi.org/10.1056/NEJMp1213760
Tsichlis JT, Del Re AM, Carmody JB. The past, present, and future of the United States medical licensing examination step 2 clinical skills examination. Cureus 2021;13(8):e17157. https://doi.org/10.7759/cureus.17157
Larsen DP, Butler AC, Roediger HL III. Test-enhanced learning in medical education. Med Educ. 2008;42(10):959–66. https://doi.org/10.1111/j.1365-2923.2008.03124.x
Ecker DJ, Milan FB, Cassese T, et al. Step up – Not on – the Step 2 Clinical Skills exam: Directorsof clinical skills courses (DOCS) oppose ending Step 2CS. Acad Med. 2018;93(5):693-698. https://doi.org/10.1097/ACM.0000000000001874
Vodden C. Licentiate to heal: a history of the Medical Council of Canada. Medical Council of Canada. 2008 pp.66-69
Touchie C, Streefkerk C. for the Blueprint Project Team. Blueprint and content specifications. Ottawa, Ontario. September 2014. Available at https://mcc.ca/media/Blueprint-Report-1.pdf
Holmboe ES. Faculty and the observation of trainees’ clinical skills: problems and opportunities. Acad Med. 2004;79(1):16-22. https://doi.org/10.1097/00001888-200401000-00006
Tamblyn R, Abrahamowicz M, Dauphinee D, et al. Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA. 2007;288(23):993-1001. https://doi.org/10.1001/jama.288.23.3019
Cadieux G, Abrahamowicz M, Dauphinee D, Tamblyn R. Are physicians with better clinical skills on licensing examinations less likely to prescribe antibiotics for viral respiratory infections in amburlatory care settings? Med Care 2011;49(2):156-165. https://doi.org/10.1097/MLR.0b013e3182028c1a
Meguerditchian AN, Dauphinee D, Girard N, Eguale T, Riedel K et al. Do physician communication skills influence screening mammography utilization? BMC Health Serv Res. 2012;12:219-226. https://doi.org/10.1186/1472-6963-12-219
De Champlain A, Ashworth N, Kain N, Qin S, Wiebe D, Tian F. Does pass/fail on medical licensing exams predict future physician performance in practice? A longitudinal cohort study of Albertan physicians. J Med Reg. 2020;106(4):17-26
Holmboe ES, Sherbino J, Englander R, Snell L, Frank JR. A call to action: The controversy of and rationale for competency-based medical education. Med Teach. 2017;39(6):574-581. https://doi.org/10.11080/0142159X.2017.13115067
Mak-van der Vossen M. ‘Failure to fail’: the teacher’s dilemma revisited. Med Educ. 2019;53(1):106-114. https://doi.org/10.1111/medu.13772
Yepes-Rios M, Dudek N, Duboyce R, Curtis, J, Allard RJ, Varpio L. The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42. Med Teach. 2016;38(11):1092-1099. https://doi.org/10.1080/0142159X.2016.1215414
Pugh D, Desjardins I, Eva K. How do formative objective structured clinical examinations drive learning? Analysis of residents’ perceptions. Med Teach. 2018;40(1):45-52. https://doi.org/10.1080/0142159X.2017.1388502
National Academies of Sciences, Engineering, and Medicine. Crossing the quality chasm: A new health system for the 21st century. 2001. Washington, DC: The National Academies Press.
National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. 2015. Washington, DC: The National Academies Press.
Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Affairs. 2019;29(7):1310-1318. https://doi.org/10.1377/hlthaff.2009.0450
Yudkowsky R, Szauter K. Farewell to the Step 2 Clinical Skills exam: New opportunities, obligations and next steps. Acad Med. 2021;96(9):1250-1253. https://doi.org/10.1097/ACM.0000000000004209
Association of the Faculties of Medicine. Entrustable professional activities for the transition from medical schools to residency. 2016 (updated in 2019). Available at https://www.afmc.ca/sites/default/files/pdf/AFMC_Entrustable%20Professional%20Activities_EN_Final.pdf
Soukoulis V, Martindale J, Bray MJ, Bradley E, Gusi ME. The use of EPA assessments in decision-making: do supervision ratings correlate with other measures of clinical performance? Med Teach. 2021;July 9:1-7 (Online ahead of print). https://doi.org/10.1080/0142159X.2021.1947480
Thoma B, Monteiro S, Pardhan A, Waters H, Chan T. Replacing high-stakes summative examinations with graduated medical licensure in Canada. CMAJ 2022;194:E169-170. https://doi:10.1503/cmaj.211816
Association of the Faculties of Medicine. Joint commitment to action on Indigenous Health. May 2019. Available at http://www.afmc.ca/sites/default/files/pdf/AFMC_Position_Paper_JCAIH_EN.pdf
Canadian Medical Association, College of Family Physicians of Canada and Royal College of Physicians and Surgeons of Canada. Virtual Care – Recommendations for scaling up virtual medical services. Report of the virtual care task force. February 2020. Available at https://policybase.cma.ca/documents/PolicyPDF/PD20-07.pdf
Canadian Interprofessional Health Collaborative. A national interprofessional competency framework. February 2010. Available at https://drive.google.com/file/d/1Des_mznc7Rr8stsEhHxl8XMjgiYWzRIn/view
Eva KW, Bordage G, Campbell C, Galbraith R, Ginsburg S et al. Towards a program of assessment for health professionals: from training into practice. Adv in Health Sci Educ Theory Pract. 2016;21(4):897-913. https://doi.org/10.1007/s10459-015-9653-6
Burdick WP, Boulet JR, LeBlanc KE. Can we increase the value and decrease the cost of clinical skills assessment? Acad Med. 2018;93(5):690-692. https://doi.org/10.1097/ACM.0000000000001867
Nevins AB, Boscardin C, Kahn D, May W, Murdock-Vlautin T et al. A call to action from the California consortium for the assessment of clinical competence: Making the case for regional collaboration. Acad Med 2022 (on-line ahead of print). https://doi.org/10.1097/ACM.0000000000004663
Thomas John J, Gowda D, Schlair S, Hojsak J, Milan F, Auerbach L. After the discontinuation of Step 2 CS: A collaborative statement from the directors of clinical skills education (DOCS). Teach Learn Med 2022 (on-line ahead of print). https://doi.org/10.1080/10401334.2022.2039154
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Claire Touchie, Debra Pugh
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.